Wednesday, December 21, 2016

Support Science-Based Medicine

The end of 2016 marks the ninth anniversary of Science-Based Medicine (SBM), our humble little project to change the world. Looking back I am pleased with the success that we have had, and daunted by the task that lies ahead.

I don’t think I am overstating the situation when I say that we are engaged in a generational struggle for the very nature of medicine and our society. There is a movement within medicine, and within our society, to devalue science and facts. They are partly motivated by greed, partly by ideology, and partly by intellectual laziness or epistemological confusion.

Our position at SBM is simple – society and our patients are best served if there is one universal science-based standard of care maintaining a minimum quality assurance for safety and effectiveness for medical practice, services, and products. We should rely upon a thorough and unbiased assessment of all relevant scientific evidence to determine if products and services are safe and effective and to inform clinical decision-making.

There is a strong consensus that treatments should be safe and effective, and that is what the public wants and expects. There is also a strong consensus about how to determine what is safe and effective, although we quibble about the small details as with any intellectual discipline. There is a meaningful difference between evidence-based medicine (EBM) and SBM, for example. We feel EBM puts appropriate emphasis on clinical evidence, but wrongly discounts scientific plausibility and prior probability. SBM advocates considering all scientific evidence in its appropriate context, and I feel we have put forward a strong argument over the last 9 years to support that position. But the similarities between EBM and SBM are what’s important – we should use science and evidence to determine best practice.

This common sense and popular position, one that is also supported by the evidence, presents a problem for certain segments of our society. Using science and evidence as the ultimate arbiter of legitimacy in medicine is extremely inconvenient to those who wish to make money by selling medical treatments that are not supported by science or evidence. They may be true-believers, or just con-artists, or some combination of the two, but in the end it doesn’t matter. They have joined forces against their common enemy – the light of scientific.

In decades past their efforts were largely deemed health fraud, but proponents of unscientific medicine have been unfortunately successful in rebranding fraud as “alternative,” “complementary,” or “integrative.” Under these vague banners they have argued that we should take a different “more flexible” approach to scientific evidence. We should change the rules of science, using weaker forms of evidence to determine efficacy. They label anything they wish to promote as “evidence-based” and support their claims with cherry-picked low-grade evidence. Sometimes they reject a scientific basis for medicine at all, promoting philosophy-based or spiritually-based medicine.

They have found allies in every political ideological camp. On the left they push anti-corporate talking points. On the right they push anti-regulation talking points. On both sides they push for “Health care freedom,” deliberately confusing lack of quality control with choice, and presenting the freedom of quacks to commit fraud as the freedom of consumers. Along the way they attack the scientific basis and legitimacy of mainstream medicine, sowing distrust and conspiracy theories.

The academic and scientific institutions that should have been a barrier to such unscientific or anti-scientific attacks on the basis of medicine have largely failed. They have failed to recognize the threat, and the true nature of the beast. They see is as fringe, or as “touchy-feely” harmless treatments. They have failed to soil their hands educating themselves about the true nature of so-called alternative treatments and its practitioners. They have failed to notice that they are becoming increasingly isolated in their ivory towers while the con-artists slowly win over their patients. They have not noticed that they have been lulled by the soporific calls for academic freedom, “patient-centered” care, open-mindedness, and other pleasant-sounding euphemisms for health fraud.

What 2016 has made clear to many who had not been paying attention previously, is that the ideologues and con-artists have mastered social media. Many people are suddenly proclaiming we are living in a “post-truth” era of “fake news.” Welcome to 2005. It only took you a decade to notice. In fairness, it has been worsening, as the mechanisms of mass deception have been honed.

The internet is now full of fake news sources, sites presenting opinion as news, and entire ecosystems of alternative reality. Further, they have become adept at undercutting the very mechanisms for exposing the fact that they are essentially fake. They realized that they can simply turn any quality-control mechanism on its head. Simply declare any opponent fake, counter any accusation with a lie, cover up the lie by lying even more. Develop your own fake reviews and declare your opponents fake. Dismiss any criticism as biased. When all else fails, make a false-equivalency argument – it’s all fake and everyone is biased.

In this world, any claim is as good as any other claim, and there is no common ground or agreed upon facts from which to even have a conversation.

Academics don’t know how to deal with this, because they are used to a nuanced world without objective truth. There is no “Truth,” only provisional conclusions based on logic and evidence, but subject to revision. It can be easy to knock them of their game by turning their own language against them. They need to be familiar with pseudoscience, with conspiracy thinking, and with the mechanisms of deception and anti-intellectualism – fields they have previously eschewed as tainted and beneath them.

Science-based medicine is a specialized movement within the broader movement of scientific skepticism and even broader rationalism. Our basic goal is to combine knowledge of science and philosophy with knowledge of pseudoscience and deception in order to push back against the forces of “post-truth.”

We have had our successes in 2016. The recent decision by the FTC (which specifically cited SBM) to require evidence of efficacy to support claims made for homeopathic products was a huge victory. Such victories are fragile, however, as evidenced by the recent passage of the 21st Century Cures Act, and the appointment of Jim O-Neill to head the FDA. O-Neill has stated that he thinks the FDA should not require evidence of efficacy prior to allowing drugs on the market. This would gut the central mission of the FDA and be a devastating blow to SBM.

What Can You Do?

There is a lot that every person interested in promoting science and reason in medicine and more broadly can do to help. First, we are opposing multi-billion dollar industries on a shoestring budget provided by small memberships. It is amazing that we have had the effect that we have, given our relatively small size and numbers, which I think is testimony to the power of our message and arguments. But we can use all the support we can get.

You can make a direct donation to SBM by clicking the donate button in the upper right of this page. SBM is produced by a non-profit educational organization, and none of our editors or writers are paid anything for their work. SBM is 100% volunteer. We have no corporate sponsors. Our income comes from ads and donations, which just barely covers the cost of hosting. SBM is a very successful blog, and with that success comes high maintenance and hosting costs.

You can also become a member of the Society for Science-Based Medicine (SfSBM). SfSBM is operationally separate from SBM and does not fund it, so both organizations can use your support.

If you are a professional, consider writing for SBM. Send us submissions. If you have the inclination you may even become a regular contributor. Also, promote the principles of SBM in your institution. Don’t be a “shruggy” when pseudoscience threatens to infiltrate your hospital or medical school. Ask critical questions. Don’t assume promoters of so-called “alternative” medicine have good motives, or that what they are doing is harmless. We need activists in every institution to promote the principles of SBM and hold the line against pseudoscience. We are here to support you.

If you are a patient (which mean everybody) then don’t be shy about asking your physician about the scientific evidence for or against their recommendations. If they recommend what you think is pseudoscience, push back. Express your displeasure. Make it clear that you expect them to base their practice on EBM and SBM principles, and if they don’t you will seek other providers. Print and give them articles from SBM – you can actually help educate your providers.

While 2016 has been a rough year for anyone who values science and reason, there may be a silver lining. I do think that awareness of the problem has increased, and this can help mobilize forces within our society to reaffirm our commitment to enlightenment principles. We are here, organized, motivated, and experienced, to deal with a problem that many people are just becoming aware exists.

Our primary goal is to educate the public about the need for science in medicine. We also need to educate academics and scientists about the true nature of the threat. We interface with the media, and with regulators. We do everything we can to make accurate and unbiased information available on social media and prominent in searches, so that people will at least find science-based information when they are looking. We can and need to do more, but we can’t do it alone.